Organization Name: | KIMBROUGH ACC MILITARY MTF |
NPI Number: | 1316142607 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TERRI KIMBROW (UBO MANAGER) |
Mailing Address: | 1434 Porter St Usadc Fort Detrick |
State: | MD US |
Postal Code: | 217029210 |
Phone Number: | 3016197675 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 04/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1100X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Military/U.S. Coast Guard Outpatient |
Taxonomy Definition: | The Defense Health Program or U.S. Coast Guard funded |